Objective: To quantify the risk of symptomatic hepatic injury associated with nonsteroidal antiinflammatory drugs (NSAIDs).
Methods: Five population-based studies were summarized to evaluate information on more than 1,000,000 patients using NSAIDs.
Results: The risk of clinically apparent liver injury was approximately 1 case per 10,000 patient-years of NSAID use. Only sulindac, associated with a 5-10-fold higher incidence of hepatic injury, differed significantly from other NSAIDs. Patients using diclofenac showed no higher incidence of serious liver disease than did patients using other NSAIDs.
Conclusion: Symptomatic hepatic effects attributable to most NSAIDs are extremely rare and usually mild.